Posts Tagged ‘NFL’

A Look into Concussion Protocols

Wednesday, March 15th, 2017

Posted March 15, 2017

Nicole T. Wasylyk
MSEd, LAT, ATC

By Nicole T. Wasylyk, MSEd, LAT, ATC

Preventing, identifying and managing sport-related concussions (SRC) continues to be a challenge for both healthcare professionals and for patients. The complexity in management of SRC may be mitigated by adopting solid policies and procedures to follow for those involved with concussion care. Best practice for concussion management encourages all high schools, colleges, club and professional sports to have policies in place regarding SRCs.

Both the National Hockey League (NHL) and National Football League (NFL) have accepted policies1,2 with the NHL adopting a new mandatory protocol this season. The purpose of the protocols is to educate players and provide guidelines for identifying and managing sports-related concussions. It has been well publicized that both the NHL and NFL face litigation from former players accusing the leagues of failing to protect them from concussions and head injuries. They also allege the withholding of information about long-term effects of concussions.3,4 These new protocols may achieve improved player education, prevention and recognition of concussion.

At their core the protocols are very similar; the NHL and NFL reference the Zurich II Consensus Statement from 2012 to define concussion as a “brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.”5 The NHL’s protocol specifically states that all players must watch an educational video and received a brochure of the information prior to the first day of training camp. All players are also required to complete baseline concussion testing, a well-adopted best practice for all contact sport athletes. Players complete both the SCAT3 and ImPACT® Test, core components of baseline testing.

The protocols both take into account thoughtful details regarding baseline and follow-up concussion testing. For example, they recognize the importance of an appropriate baseline testing setting.  Baseline testing environment and timing of the test (not immediately after physical exertion) should be considered carefully.  It is crucial for these tests to be completed in an environment where a player has minimal distractions to ensure validity of these tests.

As both protocols describe baseline testing, they also describe recognition of sports-related concussion during game play and on-field management. Signs and symptoms of concussion are mentioned in detail along with the way each league monitors for concussions. During gameplay, the NHL utilizes 2 types of spotters or individuals who monitor game play for potential athletes who may have sustained a head injury.

The first type is a Central League Spotter described as an Athletic Trainer (AT) or athletic therapist who observes the games via multiple live game feeds in the NHL offices. The second is an In-Arena League Spotter described as an Off-Ice Official who observes the game live in the arena. If either spotter suspects a player has sustained a concussion the player is then taken off ice and assessed by the club’s medical personal as described in the protocol. In contrast, the NFL only describes a Booth Athletic Trainer; this individual serves as the spotter similar to the Central League Spotter for the NHL.

If an NFL player is suspected of having a concussion during a game, they are removed from play and assessed as described by the “Madden Rule.” This rule states that the player must be removed from the field and evaluated in the locker room area by medical personal. If medical staff concludes a concussion was sustained that player is not permitted to return to play the same day. If no concussion is suspected, then video of the game play must be reviewed to remove any doubt of head injury prior to allowing the player to return to participation. The NHL describes assessment similar to the NFL’s “Madden Rule.” Return to play progression is also outlined in both protocols and both leagues encourage a multidisciplinary team approach to treatment. The medical teams are comprised of either a neurotrauma consultant or neuropsychologist along with the team medical doctors and ATs.

These concussion protocols serve as a comprehensive approach to education, diagnosis and management of sports related concussions. It is important that a transparent policy is adopted as a part of best practice so players, coaches, medical staff and officials understand not only the actions to take to protect athletes but expectations surrounding concussion recognition, management and return to sport.

References

1.https://images.nflplayers.com/mediaResources/lyris/pdfs/NFL_Diagnosis_Mgmt_Concussion.pdf

2.https://nhl.bamcontent.com/images/assets/binary/282574512/binary-file/file.pdf

3.http://www.cbsnews.com/news/supreme-court-rejects-former-players-challenge-1-billion-nfl-concussion-settlement/

4.https://www.boston.com/sports/boston-bruins/2016/02/06/105-former-nhl-players-are-plaintiffs-in-class-action-concussion-lawsuit-against-league

5.http://bjsm.bmj.com/content/47/5/250.full

 

Resources

https://www.nata.org/sites/default/files/Concussion_Management_Position_Statement.pdf

http://www.bocatc.org/blog/athletic-trainers-in-the-news/concussion-baseline-assessments-what-should-clinicians-capture/

About the Author

Nicole Wasylyk works as an Athletic Trainer in a physician practice at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire. Prior to DHMC she resided in Madison, Wisconsin and was an Athletic Trainer in a physician practice at Meriter-Unity Point Health. Wasylyk obtained her Bachelor of Science in Athletic Training from Boston University and Masters of Science in Education from Old Dominion University. She has completed a residency program for healthcare providers who extend the services of a physician at UW Health. Wasylyk also obtained her orthopedic technician certification. Her professional interests include injury surveillance and prevention, standardization of best practices and patient reported outcomes collection. 

 

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“Concussion” – A Movie Review from an Athletic Trainer’s Perspective

Friday, February 12th, 2016

Posted February 12, 2016

By Claudia Curtis, MS, LAT, ATC

As a moviegoer, I found “Concussion” to be very well done. The plot flowed well, did not feel too drawn out and the acting was superb. Will Smith did an excellent job portraying the main character, Dr. Bennet Omalu, taking you on his journey and making you feel what he felt.  It gave insight into what was happening behind the scenes for years regarding chronic traumatic encephalopathy (CTE) before the American public was aware of the situation. The movie was produced in a way to keep all kinds of viewers engaged, science for the healthcare professionals, game footage for the sports enthusiasts. The footage shows a lot of big hits, frequently without proper technique. In terms of a cinematic experience, I was pleased with my movie choice.

However, as an Athletic Trainer (AT), how did I feel watching “Concussion?” First and foremost, I was horrified at the way  ATs were portrayed in the movie. This movie focused mainly on the neuroanatomy and the discovery of CTE, not necessarily something  Athletic Trainers have a role in. However, there is one scene where “trainers” are mentioned, and it is done in a rather ignorant way. The scene discusses the fact that the NFL did research prior to Dr. Omalu regarding the presence of CTE.  However, the “researchers” named on the study were a rheumatologist, an equipment manager and a “trainer.” The response to that comment was, “Don’t they just tape knees?” This is a pretty large stage for our profession to be improperly represented, leaving a bitter taste in my mouth that lingers even now.

The impressions I took from this movie span far beyond that one scene though. This movie made me feel a variety of emotions: sympathy, anger, fear and confusion to name a few, alternating throughout the scenes. The person I saw the movie with, a non-healthcare professional, after the movie said, “I wish they had given us more information about what’s been learned since this all started.”

What I realized is that there aren’t a lot more answers right now, but rather that more questions have developed with time and research. How many years of impacts might cause CTE? Does it matter the level of sport played (high school vs. college or professional sports)? Does it matter if consciousness was lost? Are we doing the right thing to prevent this in our concussion recovery programs? Will these concussion return protocols prevent CTE?

I could probably fill an entire page with questions. There is one I’m still asking myself: Is this movie enough to convince high school kids of the real danger that concealing concussions could have long term?

In-Depth Look: Meet the Head Athletic Trainer for the NFL Denver Broncos

Wednesday, January 20th, 2016

Stephen L. Antonopulos, ATC is the Head Athletic Trainer (AT) for the Denver Broncos Football Club.  His is responsible for the medical services for as many as 90 potential football players, coaches and organizational staff.

Describe Setting:  

My setting is with the Denver Broncos Football Club.  We have 2 main team physicians: one orthopedic physician, who is our main team physician, and one internal medicine team physician.  Approximately 25 consultants who work with us as well.  We also have a variety of other staff, including 2 massage therapists and 3 chiropractors.  I am the head AT and have 4 full time AT assistants.  In addition, we have 2 seasonal athletic training interns who work with us each day during the organized team activities (OTAs), summer camp and the season.  During summer camp, we employ 4 additional students from colleges around the United States.

How long have I worked in this setting?

I am starting my 40th season with the Denver Broncos.  I spent 4 years as an Assistant AT before being named the Director of Rehabilitation.  I have spent the last 35 years as the Head AT.

Describe a Typical Day? 

A typical day for me starts at 4:00am.  I am an early person, and I learned years ago I need some time by myself before anyone gets here.  I use the time to work out and do administrative tasks.

The players arrive for treatment at 6:30 am, and the player meetings start around 8:15am.  We have long-term rehabs while players are in meetings.  That way, we are either working with them or doing administrative work.  Practice is from 11:30am to1:30pm.  From 1:30am to 3:00pm we work on post practice treatments.  There is another player meeting from 3:00pm to 4:00pm.  Post practice treatments follow until we are done at approximately 6:00pm.

What do you like about your position?

I can honestly say in 40 years, I have never had a day that I dreaded coming to work.  I love my job.  I work for a great organization that cares about people.  I love caring for people.  I love the relationships I have developed over the years.  I love being around young people who keep me young.  I love the challenges that are presented each day.  I love the energy required to survive in this game.  I have spent over half of my life working for the Denver Broncos, and I love the Denver Broncos! 

What do you dislike about your position?

The worst part of the job is seeing players devastated by being injured.  It is their livelihood, and it hurts to see them be injured and not be able to perform.

What advice do you have for a young AT looking at this practice setting? 

There are very few positions in athletic training at the professional football level.  The positions are hard to come by and everyone wants to be here.

When I was a kid, I use to watch the Broncos on TV with my father.  I said that somehow or someway I was going to work for the Denver Broncos someday.  I am living a dream.  Of course, you don’t just decide to live a dream and it happens.  To me, prospective ATs have to consider 4 things.

1. You have the passion to do it.  If you don’t have passion, you are in the wrong field.

2. You have to be of great character.

3. You have to have great work ethic!

4. You have to have an opportunity.  Sometimes those opportunities fall in your lap. Other times you have to make the opportunity.

We have internships in our program.  I can honestly say those internships are job interviews.  All the individuals on my staff are former interns.  They all showed the passion, character and work ethic that is required.  In addition, I like my assistants to have a graduate degree.

This is a positive environment, and I require positive people.  Most of all, I encourage you to not be in a hurry to get to the top.  It takes passion, character and hard work to get there.  That does not happen overnight.

 

In-Depth Look: Meet an Athletic Trainer for an NFL Team

Thursday, September 24th, 2015

T. Pepper Burruss is the Director of Sports Medicine Administration and Athletic Trainer/Physical Therapist for the Green Bay Packers.

Describe your setting:

Our athletic training facility was recently renovated, and we have only been in it since July.  It includes an expanded treatment area, functional rehabilitation area, recovery room, examination rooms, GE iDXA body scan room, digital X-ray room, 4 Athletic Trainer offices, conference room, hydrotherapy room with 2 walk-in hot tubs and a walk-in 4 x 16 cold tub, and a SwimEx rehabilitation pool - all surrounded by 11-foot tall walls of glass.  You can never have enough storage space, but we’ve been very fortunate to have an attached 2-level stock/work room that accommodates all of our supplies as well as our array of travel trunks, last but not least, an ice machine/cooler storage room.

In 2013, we were fortunate to have an addition to our building that houses a 10,000-square-foot weight room and an adjacent regulation width indoor 35-yard in-filled field. The addition, called the Conditioning, Rehabilitation and Instructional Center (CRIC), is a valued adjunct to our strength and conditioning program and to our rehabilitation regimes.

How long have you worked in this setting?

This is my 39th season in the National Football League (NFL). I spent the last 23 seasons with the Green Bay Packers and the first 16 with the New York Jets.  I trace my career path to the choice to move from New York state to attend Purdue University under the legendary NATA Hall of Famer, William “Pinky” Newell.

As I was leaving high school in 1972, a chance encounter made me aware of the many Purdue graduates with influential athletic training jobs all across the country.  Several of those were in the NFL, which I had my sights set on at a very early age.  With that, I decided I needed to be mentored by the best; after all, Pinky was known to have the most high profile job opportunities come across his desk.

It was 800 miles from my New York state hometown to Purdue University.  Pinky wrote to me (I think I still have the hand written letter) that it was an awful long way for an out-of-state student, and he couldn’t guarantee me a spot in the athletic training facility.  I wrote back that I was coming.  Years later Pinky confided that my decision to make the trek showed I was determined and willing to put my money where my mouth was.

After Purdue, I chose to attend Northwestern University Medical School to receive my second bachelor’s degree in physical therapy.  Then, eight weeks prior to my graduation from Northwestern, I received a call from Bob Reese, the new Head AT of the New York Jets and 1970 Purdue alumni. He asked if I wanted to be the Assistant Athletic Trainer of the Jets. Keep in mind, this is my home state and “my” team growing up. Bob and I had met in 1972 when I was considering attending Boston College, where he was employed as the youngest Head AT in Division 1 football. Years later, Bob made a call to Pinky seeking a recommendation of a Purdue grad he might hire, and as they say, “the rest is history.”

I spent 16 seasons with the New York Jets as an Assistant AT.  In 1991, the Jets Director of Player Personnel, Ron Wolf (2015 NFL Hall of Fame inductee) became the general manager of the Green Bay Packers.  He called me in early 1992 and asked me if I would be interested in becoming the Head AT of the Green Bay Packers after the late Dominic Gentile retired.  I wasn’t quick to jump at the offer, as the Packers had been through a rough stretch of 25 years of mediocrity.  (I also thought it was truly the “frozen tundra” with more snow than grass.)  Several months later, I decided this was the right decision for my family.  Dominic retired after the 1992 season, and I joined the Green Bay Packers January 1, 1993.

Describe your typical day:

My typical day is the same as most any full-time AT working the “daily grind.”  We come in when it’s dark, and we leave when it’s dark.  There is not a typical day as each has its varied challenges depending the time of year, intensity of the week and a never-ending administrative load.  I firmly believe all ATs feel an unceasing commitment to try to get the job done every day.  Over the years, I’ve learned that it is never done. We could work 24/7, and we’d never get everything done because healthcare is never done.  Sadly, athletic training is not a 9-to-5 job. It’s a serious commitment. Those who passionately embrace it succeed.

So many things are happening:

With the exponential pace of technological advancements, the athletic training world rides along.  It makes for an exciting time, and future, as the technological growth advances our techniques, overall attitudes and initiatives.

Technological advances become tangible through diagnostics, enhanced MRI and digital X-ray systems (now retrievable on the sideline), concussion and helmet studies, foot/ankle/turf interface advancements, computer enhanced modalities, infectious disease control, rehabilitation techniques, injury statistical/video analysis, bracing and protective gear enhancements, electronic health records (EHRs), telemedicine diagnostics and more.

National initiatives, by the likes of the Centers for Disease Control and Prevention (CDC) and multiple professional sports leagues, make us more introspective about how we go about our business.  Such initiatives address concussion care (as with the Zack Lystedt Law), acute spine injury protocol reviews and DEA enforcement of controlled medications with athletic teams. It is no longer “business as usual.”  We’re looking to evidence based research to refine everything we do in, and about, the athletic training facility.  It becomes evident athletic medicine is no longer just local, it is national and international.

In the early 70s, Pinky dreamed of an endowed NATA scholarship, and now there are dozens.  He was excited to welcome the first female member of the NATA, and now women are our majority. They are past presidents, executive directors and employed in many male-dominated sports.

To think, I look back at “computer, arthroscopy and MRI” as the major advancements in my time.  What will be your “computer, arthroscopy and MRI” to look back on and say, “Wow, how far have we come and how far will we go?”

Athletic Trainers contribute significantly to making football safer, but it is inherently a collision sport. We cannot eliminate injuries.  People say to me, “Keep ‘em healthy.”  I respond, “That’s God’s work; I just do the helpin’.” If we are going to take credit for a team being healthy, we better be ready to assume credit when they are not.  I choose not to take any credit.  If you are going to take credit for the good, you better take credit for the bad too.

What do you like about your position?

Game day is undoubtedly the “glitz and glimmer” of the NFL.  Game days are special. They’re electric. The more important the game, the bigger the “high” is of a win – or the lower the “low” of a loss.

For anyone who has ever been in a fraternal group – like with the military, police, firefighters or various teams – there is nothing compared to the relationships you build in the locker room.  There is not a player who retires from the game who says they miss lifting weights, being sore and getting beat up.  They always say, “I’m going to miss the locker room.”  You can’t help but appreciate the people and relationships.  I love being relevant and included as a part of the locker room.

I think there is an inherent ego that comes with the glitzy jobs, whether they are in with a big-time college, professional team or the Olympics. It’s just an honor to be a part of it.  There is something to be said for the NFL – the travel, resources, budget, glitz and glamour – and I believe it can become addicting.

You never grow tired of walking out of the stadium tunnel, listening to the home-field introductions and the national anthem being played. It’s a super rush if there is a military fly-over!  It wasn’t until last season, after 37 years in the league, that I realized something. Packers Equipment Manager Gordon “Red” Batty and I were out on the field during a timeout, when he said to me, “Pepper, think about this. None of those people on the sidelines can walk out into the middle of the field during a game, and you and I can. How fortunate are we?”  I had never thought of it that way before.  The assistant coach, video staff, security or ball boys cannot venture out into the middle of the field.  It falls under the moniker of nothing compares to game day.  Sometimes you fail to realize how good you have it; I’ve been very, very, very fortunate.

What do you dislike about your position?

I’ve said this a thousand times; my least favorite part of the job is the grind of the hours.  With the typical hours an Athletic Trainer works, it takes a concerted effort to maintain some normalcy to family/home and leisure life.

I would say another thing that I find challenging is the vast corporate world of the NFL.  The players have multimillion dollar salaries.  I struggle with the politics of dealing with all that comes from an entourage of agents, medical consultants and caregivers who advise and direct the players beyond our concerted efforts.  Many of these folks have nothing more than a business relationship with the player, yet, in season, we spend more waking hours with them than we do our own families.  The pressure on the players gives rise to a challenge of balancing the many outside influences their personal medical advisors bring to the table in relation to the care rendered in our facility.

What advice do you have about your practice setting for a young AT looking at this setting?

Choose the best school that fits your circumstances.  Build an impressive résumé and network with people in your chosen field.  I started my career by choosing a school that featured a pioneer in the athletic training field.  I was able to build and develop the skill set that helped shape me for the profession and the career I sought.

I tried to never turn down an opportunity to build my résumé through volunteering, taking an additional class or seeking insightful experiences. Students and young ATs need to understand there is mega competition for the glitzy jobs. There are many bright, highly educated students, but so many of the résumés look exactly the same.  I think a goal for a young AT should be to make their résumé likely to move from the big pile to the small pile.  You have to seek people who can advise you how to best accomplish that.  It is not by having the fanciest paper with the designer font.  It’s by having loads of experiences in and out of your desired field/profession that makes your résumé pop.

Every year, we receive piles of résumés from students and professionals who are applying to be a summer or seasonal intern.  My preference is that the résumé not be in a tiny font to make it all fit on a page.  I am not a proponent of the 1-page résumé.  If your hobbies, interests and voluntary efforts could move your résumé from the big pile to the small pile, isn’t that worth an additional page?

Little mistakes can also make a big difference in the review of a cover letter and résumé.  We get letters via surface mail that have not been signed.  I understand that void with emails, but not taking the time to sign a hardcopy is a mistake.  Maybe it’s a small thing, but it is attention to detail and it catches my eye.  The ultimate transgression is a mismanaged mail merge that combines a staff member’s name with the wrong team name.  Proofread your letter and make sure you have the correct information included.

Certainly you can’t understate the need to network.  There is no better place to network than your local, state, district and national NATA meetings.  Realize the classmate or AT intern you sat next to in a lecture hall may one day be in a position to recommend, or even hire you, for a job. You cannot afford to be short-sighted about networking, meeting other students, competitors and show exhibitors. Take the time to put a name and handshake with a face.

Résumé references are important and especially good if they happen to be known to the staff you are applying to for a position or internship. For a potential employer to know a reference by name and reputation puts some “oomph” to their recommendation.  Some of the teams give preference and geographic loyalty to in-state institutions, whereas some offer opportunities to those from around the country.  Just take the time to construct your letter and résumé in such a way it has a better-than-average chance to move from the big pile to the small pile.

Don’t set your sights on attaining “average.”  That just means you are better than some folks, but a batch of folks are better than you.  Lastly, don’t set you goals too low; you are liable to reach them!

 

 

An In Depth Look with an Athletic Trainer with the Buffalo Bills

Friday, November 16th, 2012

An In Depth Look with an AT in the NFL...Shone Gipson, ATC

Describe your setting:
I work as an AT for the Buffalo Bills of the National Football League.

How long have you worked in this setting?
I’ve been a BOC Certified AT since 2001 and working in this setting for 10 years.

Describe your typical day:
My typical day is like that of many Athletic Trainers. We have early mornings taking care of players performing numerous treatments and rehabilitative care. We divide up most of the administrative duties among our staff throughout the day and provide practice coverage for our athletes.


What do you like about your position?
I like the one on one interaction I get to have with our players who are involved in rehabilitation. Getting to know them and watching them progress back from an injury is truly worthwhile.

What do you dislike about your position?
I dislike being away from my family, at times. It's especially tough during the holidays when my family is in Texas and I'm in Buffalo, New York working.

What advice do you have about your practice setting for a young Athletic Trainer looking at this setting?
Work hard and be willing to put in extra time to improve upon your craft. Your positive energy and vision must be greater than anyone's and everyone's negativity. Your certainty must be greater than everyone's doubt. That is how individuals work and succeed at this level of the profession.

Athletic Trainers Aid in the Prevention of Heat-Related Injuries and Deaths

Thursday, July 26th, 2012

This week NFL football training camps kicks off. With the hot summer weather, special care must be taken to ensure that athletes practicing and working out in hot, humid conditions properly hydrate.  The days are long gone when it was considered a sign of weakness when an athlete would stop during practice and drink water.

Eleven years ago Korey Stringer, Minnesota Vikings offensive tackle, died of heat-related complications during NFL training camp. The Korey Stringer Institute (KSI) at the University of Connecticut is making sure teams and coaches are taking measures to avoid any heat-related deaths or complications. KSI is partnered with the NFL and is one of the leading institutions studying athlete heat and hydration issues. You can reach more about KSI from the BOC’s September 2011 blog Heat Illness Education and the Role of ATs.

The National Athletic Trainers Association (NATA) released guidelines aimed at preventing sudden, heat-related injuries and deaths.  These guidelines are based on proven ideas that incorporate common sense into summer workouts.  Read the summary of these guidelines.

“The NCAA adopted NATA's guidelines in 2003, and since then there has not been a single heat-related death in sports,” said Rebecca Stearns, KSI’s director of education and vice president of operations. “KSI's next target is high school sports,” Stearns said, “ where the number of heat-related deaths has nearly tripled over the last 15 years, according to University of Georgia Climatologist Andrew Grundstein.”

“Less than 50 percent of high schools have Certified Athletic Trainers on site, so the warning signs for heat illness can go unrecognized,” Stern said. Georgia high schools have a practice policy for heat and humidity after two Georgia high school football players died last year during summer workouts. August 1st is the first day that schools are permitted to allow football players to be in full pads under the Practice Policy for Heat and Humidity implemented by the Georgia High School Association (GHSA).  Read more about heat illness prevention and learn more about what other Athletic Trainers are doing in the article Weather a Hot Topic as Football Season Kicks Off.

According to the NATA, signs of heat exhaustion include thirst, headache, dizziness, nausea, cramps, excessive fatigue and dry mouth. If experiencing these symptoms, athletes should be moved to a cool environment or into the shade immediately and rehydrate with an electrolyte-containing drink like Gatorade.

Written by: Brittney Ryba
BrittneyR@bocatc.org

Brain Donation to Science Brings MTBI Awareness to Communities and Legislation

Wednesday, February 23rd, 2011

The ABC morning show Good Morning America had a piece today about former NFL player Dave Duerson. Mr. Duerson donated his brain to science. He specifically asked that to study the long-term effects of football on the brain.

It's difficult to open a newspaper, website, or magazine related to sports and NOT see something about concussion. Multiple state legislatures have bills pending designed to regulate the safety of interscholastic athletes who receive a concussion or mild traumatic brain injury (MTBI). The NFL and the NATA have partnered to bring this issue to the forefront of all legislators.
 
The guidelines and recommendations for treating this injury continue to evolve. Once pertinent position statements and guidelines are becoming -of-date as new research on the evaluation and treatment programs for individuals with MTBI emerge. ATs are continually educating themselves through local and national continuing education programs in order to stay abreast of the most current evidence-based practice. The continuing competence requirement to hold the ATC® credential is just one reason the AT is invaluable to parent, patients, students and the community. Athletic trainers (ATs) are often the healthcare professional on-site when the initial injury occurs. They make the first assessment and diagnosis keeping the patients best interests in mind at all times.

What is your community doing to increase the number of ATs serving the active population in your area?